Provider Demographics
NPI:1487855862
Name:JACOBSON, REBECCA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OLD HILL FARMS RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3034
Mailing Address - Country:US
Mailing Address - Phone:203-227-8764
Mailing Address - Fax:203-222-7085
Practice Address - Street 1:18 OLD HILL FARMS ROAD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3034
Practice Address - Country:US
Practice Address - Phone:203-227-8764
Practice Address - Fax:203-222-7085
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0022771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140000227CT01OtherBLUE CROSS BLUE SHIELD
CT002277OtherSTATE LICENSE